Two to Tango: Using Positive Communication When Someone has Dementia (Part I)

by Kimberly Johnke, LSW
February 21, 2012
View and Print Full Document (pdf)
Oast & Hook staff members recently attended a hands-on educational workshop facilitated by dementia care expert Teepa Snow. The seminar was full of valuable insights and advice on effectively communicating with individuals with dementia, with special emphasis on fostering a positive relationship that reduces stress on both the impaired individual and the caregiver. (For the purposes of this discussion, dementia will include all forms of dementia, including Alzheimer’s disease.) Oast & Hook found the information so useful that it now shares what we learned in a two-part series in an effort to help others navigate the waters of managing a relationship with a loved one with dementia.
First, Ms. Snow stressed the need for caregivers to recognize dementia as a form of brain failure and not simply a “memory problem.” The brains of individuals with dementia are undergoing progressive deterioration which eventually affects nearly all areas of functioning − from the ability to recall events, exercise judgment, and control impulses, to the loss of language and field of vision. Taken together, these physiological changes impose significant limitations on the ways in which an individual with dementia is able to relate to the world. Generally speaking, the brains of individuals with dementia “lose left and retain right,” where the left brain controls language and speech and the right brain controls the rhythm of speech, music, prayer and song, as well as, er, well, expletives. (More about this later.)
For example, an individual with dementia will, on average, miss one of every four words spoken to this individual. It’s not that the individual can’t hear what is being said: Auditory perception is one of the few brain functions to remain intact in the individual with dementia; however, the ability to comprehend language (a left side function) is gradually lost. Interestingly, the part of the brain that controls the rhythm of speech (a right side function) remains intact. This is why the sometimes nonsensical speech of a person with dementia maintains the hallmarks of conversational tone. It’s also why our loved ones with dementia may shout expletives when frustrated: As their range of vocabulary diminishes in the left brain, they rely more on the use of the right brain, which, as previously mentioned, stores all of those colorful words we try so hard not to let slip. According to Ms. Snow, some other functional and behavioral changes that can occur as a result of dementia include:

  • Confabulation, or the act of making up facts to replace lost memories. This is the brain’s way of compensating for a lack of information that can leave the individual with dementia feeling frustrated and confused. Confabulation helps to fill in the gaps. Interestingly, the individual with dementia can remember the emotional tone of a past interaction, even if this individual cannot recall the actual facts surrounding the encounter. For example, if a past interaction with a caregiver felt unpleasant or upsetting to the individual with dementia, then this individual may react to a future interaction with the caregiver with resentment, fear, or guarded suspicion − perhaps “recalling” (confabulating) untrue events that are leading this individual to approach the caregiver in a cautious manner.
  • Peripheral Inattention, or the loss of field of vision. Imagine you are looking through binoculars. (With each hand, curl your thumb and index fingers to create a circular “binocular” effect and hold them to your eyes.) Now, determine whether your shirt is soiled. That’s right; you can’t see it to know. This is essentially what happens to individuals with dementia: As the part of the brain controlling peripheral vision continues to deteriorate, they increasingly experience the world through “binocular” vision. Combine this organic change with normal, age-related visual decline and the mental confusion of dementia, and you’re left with a recipe for disaster. Grimace in frustration at the person with the soiled shirt, and you’ve set yourself up to endure another bout of confabulation.

So, what to do? Stay tuned for specific tips next week in Part II of Two to Tango.
To learn more about the work of Teepa Snow, visit www.teepasnow.com.
The attorneys at Oast & Hook can assist families with their estate, financial, insurance, long-term care, veterans’ benefits, and special needs planning issues.
Kimberly Johnke is a licensed social worker with more than 15 years of professional experience serving disabled and chronically ill individuals. In her role as Life Care Planning Specialist at Oast & Hook, Ms. Johnke provides individualized services to assist families throughout the life care planning process.

Ask Allie

O&H: Allie, we’ve heard that Ecco D’Oro recently had an adventure in New York City.  Please tell us about it.
Allie: Sure!  We met local dog Ecco a few weeks ago.  He recently competed in the Westminster Kennel Club Dog Show in New York City, and he also served as travel correspondent for Everyday Opera, an online magazine.  He met Janet Hopkins, an opera singer with the New York Metropolitan Opera, who has worked to promote pet adoption and animal welfare.  Although Ecco did not win at Westminster, he had a great time on his trip.  Good job Ecco, and we can’t wait to read more about your time in New York City.  Time to play . . . See you next week!


Seniorcorp will present a free seminar entitled “Understanding Hospice” from noon to 1:00 p.m., Tuesday, February 28th. This seminar will be held at Seniorcorp, 240 Clearfield Avenue, Suite 300, Virginia Beach, Virginia, 23462. Seating is limited so please register by phoning 757-419-2356 on or before February 24th.


If you are interested in having an Oast & Hook attorney speak at your event, phone Darcee Hale at 757-399-7506. Past topics include estate planning, long-term care planning and veterans benefits.

Distribution of This Newsletter

Oast & Hook encourages you to share this newsletter with anyone who is interested in issues pertaining to the elderly, the disabled and their advocates. The information in this newsletter may be copied and distributed, without charge and without permission, but with appropriate citation to Oast & Hook, P.C. If you are interested in a free subscription to the Oast & Hook News, then please e-mail us at mail@oasthook.com , telephone us at 757-399-7506, or fax us at 757-397-1267.
This newsletter is not intended as a substitute for legal counsel. While every precaution has been taken to make this newsletter accurate, we assume no responsibility for errors, omissions, or damages resulting from the use of the information in this newsletter.